Inpatient hospice is the exception rather than the rule.
The Medicare hospice benefit in the United States provides palliative, or comfort, care to people in the home through a combination of medications, medical equipment and visits from a multidisciplinary health team. Medicare guidelines acknowledge, however, that the most effective care is not in the home. In some cases, Medicare will pay for hospice patients to receive inpatient care.
Inpatient Respite
Inpatient respite care gives the patient's primary caregiver a break. Inpatient respite care lasts no longer than five days at a time and takes place in a hospice facility of skilled nursing facility. Medicare guidelines once required the facility to have a registered nurse (RN) on duty 24/7, but those requirements are longer necessary. The patient may be responsible for up to five percent of his stay in inpatient respite.
Inpatient Acute
Acute inpatient care is when the patient's pain or other symptoms are not manageable in the home. Examples include continuous seizures or vomiting, uncontrollable agitation and extreme pain. Inpatient care takes place in a hospital or hospice facility. There is no specific time limit for acute inpatient care, but the Medicare benefit stops paying after controlling the symptoms and in-home care resumes.
Custodial Care
Some people go to a nursing facility or an assisted living facility because they need help with their basic daily care needs such as bathing, getting dressed, taking medications or eating. The hospice Medicare benefit does not pay for this type of inpatient care. Possible payor sources for custodial care include private pay, long term care insurance and Medicaid.
Aggressive Care
Some people check into a hospital because they want aggressive treatment for their life-limiting illness. Medicare hospice benefits do not pay for curative care. They pay only for comfort care. Anyone wanting to go into the hospital to seek aggressive treatment needs to sign hospice revocation papers giving up the hospice Medicare benefit. When the person is discharged from the hospital, he or she may sign up with hospice again if palliative care is still the most appropriate treatment for his or her condition.
Inpatient Care for an Unrelated Condition
Occasionally, someone receiving the Medicare hospice benefit needs to go to the hospital to be treated for a condition unrelated to his or her hospice diagnosis. A lung cancer patient, for instance, who falls and breaks a hip would require hospitalization for the broken hip.
In this case, the hospice would provide the hospital with a comprehensive plan of care for the patient. Hospice team members would make daily visits to check on the patient's comfort, provide support, and ensure that the hospital was not treating the patient for his or her hospice diagnosis.
The inpatient stay itself would be paid of by the patient's regular Medicare benefits and any secondary (Medigap) insurance the patient might have. This is one of the few times when a person can access hospice Medicare and regular Medicare at the same time.
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